=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669346813
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VANESSA DAWN MAIN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/01/2025
-----------------------------------------------------
Last Update Date | 10/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 643 GREENWAY RD STE L
-----------------------------------------------------
City | BOONE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28607-4840
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-263-6123
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 539 PLEASANT VALLEY RD
-----------------------------------------------------
City | MOUNTAIN CITY
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37683-6122
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-530-1685
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | P020927
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | LCAS-29945
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------